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Taking Duphaston for PCO. Is it correct that Duphaston should be taken in second half of cycle?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
I am a 29 years old lady and i have been diagonosed as PCO one year back. Since I have been taking Fertomid (150 mg), Folvite, Metforin (500 mg twice a day) and Duphaston 10 mg (twice a day for Day 5 - Day 25 of my cycle). My ovulation is right (as per follicular minitering) and eggs rupture. But I have not been able to concieve even after trying for 4-5 months now.

I consulted another doctor who told me something very shocking that duphaston shoould be taken in the second half of the cycle (from 14 to 17 day onwards) to support pregnancy. If taken in the first half of pregnency (as I was taking from 5th day onwards) it acts as a contraseptive in itself. Please let me know if this info is correct as I am really desperate to concieve now and cannot believe my gyne can give such a wrong advise for 5 months in continuation.
Posted Thu, 12 Apr 2012 in Infertility Problem
Answered by Dr. Hema Yadav 4 hours later
Thanks for posting your query.
Duphaston is an active progestogen (dydrogesterone) to be taken orally. Its action takes place directly on the uterus, producing a complete secretory endometrium in an estrogen-primed uterus.

At therapeutic levels, Duphaston has no contraceptive effect. It does not influence ovulation or the corpus luteum. This medicine is non-androgenic, non-estrogenic, non-corticoid, non-anabolic. The dose of duphaston depends on the type of hormonal problem.

If with PCOS, you have luteal deficiency and therefore infertility then the dose is 10 mg. for last 14 days of cycle so the second doctor has given you right information. However in endometriosis and dysfunctional uterine bleeding or irregular cycles it may be given from fifth day of cycle usually along with estrogen.

In some cases it might have a contraceptive effect specially in higher doses. So do consult your gynaecologist and have a XXXXXXX discussion about this. It's possible that your condition might have required the particular dose.

Hope, this answers your query. Please accept my answer in case you have no follow up queries.

Above answer was peer-reviewed by
Follow-up: Taking Duphaston for PCO. Is it correct that Duphaston should be taken in second half of cycle? 58 minutes later
Thanks a lot Doctor for your opinion. My periods were regular and I also do not had any other problems as mentioned above by you. I even do not think that I was given the dose along with estrogen.

Can you please quantify what you mean by the high doses for Duphastan. Is 10 mg of dose twice a day is high dosage.

I am really worried with two different opinions and need an independent opinion from you about this?

Also do you think that I need endometrial biopsy at this stage?
Answered by Dr. Hema Yadav 3 hours later
Hello ,
Thanks for the follow up.
Since you have asked for an independent opinion I would like to mention few things.

Fertomid(clomiphene) is indicated in cases where there is inability to conceive due to ovulatory failure. It is usually not used when there is no diagnosis or when ovarian induction is not needed i.e normal eggs production and release is monitored without clomiphene.
Duphaston (progesterone) is indicated only when there is deficiency of this hormone(luteal insufficiency). If your blood level of progesterone (during luteal phase) is normal, then consumption of this medicine will do little good and lot of harm. You can wait for another few months (say, 4 months) with only metformin, that too if required and lifestyle modifications and
see the results.You should exercise daily atleast brisk walk for thirty minutes, eat a balanced diet and take adequate sleep. If this doesn't help then you can go for ovulation inducing drugs like fertromid and pregnancy maintaining drugs acting on endometrium like duphaston .If that too doesn't work then you should go for further work up like endometrial biopsy or laparoscopy .
Now the answer to your first question is 10_30 mg. daily will be considered low dose and such low dose taken from 5 th day of cycle is a standard treatment for endometriosis.Some gynaecologists do give higher doses like 30_60 mg but the choice depends on patients condition.
So please consult your gynaecologist regarding your exact diagnosis causing infertility ( apart from pcod) and if uncertain then you may go for further work up to confirm the diagnosis.
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